三种黄体支持方案在激素替代周期冻融胚胎移植中妊娠结局的比较  

Comparison of pregnancy outcomes of three luteal support protocols in frozen-thawed embryo transfer during the hormone replacement cycle

作　　者：张文[1] 于晓娜[1] 任炳楠 管一春[1] 乔洪武[1] 王婧彦[1] Zhang Wen;Yu Xiaona;Ren Bingnan;Guan Yichun;Qiao Hongwu;Wang Jingyan(Reproductive Center,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第三附属医院生殖中心,450000

出　　处：《中华生殖与避孕杂志》2021年第11期966-972,共7页Chinese Journal of Reproduction and Contraception

摘　　要：目的:探讨三种不同黄体支持方案对激素替代周期冻融胚胎移植(hormone replacement therapy frozen-thawed embryo transfer,HRT-FET)中妊娠结局的影响。方法:回顾性队列研究分析2016年1月至2019年2月期间在郑州大学第三附属医院生殖中心接受HRT-FET的3288个周期,根据不同黄体支持方案分为三组。A组为黄体酮软胶囊联合地屈孕酮片组(478个周期),B组为黄体酮阴道缓释凝胶联合地屈孕酮片组(1923个周期),C组为黄体酮针剂联合地屈孕酮片组(887个周期)。分别比较三组的妊娠结局及新生儿结局。结果:A组、B组和C组间的临床妊娠率、12周妊娠率、移植周期活产率差异均无统计学意义(P均>0.05),早产率和双胎分娩率C组高于B组[19.90%(78/392)比13.61%(109/801),P=0.011;30.61%(120/392)比20.47%(164/801),P<0.001],差异均有统计学意义,B组新生儿体质量[(3178.60±635.38)g]高于C组[(3033.01±682.54)g],差异有统计学意义(P<0.001),三组间新生儿出生缺陷发生率差异无统计学意义(P>0.05)。logistic回归分析显示,三组不同黄体支持方案并不是12周妊娠率的独立影响因素。结论:在HRT-FET周期中,黄体酮软胶囊或黄体酮阴道缓释凝胶联合地屈孕酮片,均能取得与黄体酮针剂联合地屈孕酮片相似的妊娠结局,但仍需要大样本前瞻性研究证实。Objective To investigate the effects of three different luteal phase support protocols on pregnancy outcomes in hormone replacement therapy frozen-thawed embryo transfer(HRT-FET).Methods The clinical data of 3288 HRT-FET cycles in Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2016 to February 2019 were retrospective cohort study analyzed.The cycles were divided into three groups according to luteal phase support protocols.The patients received a combination of progesterone soft capsule and dydrogesterone in group A(478 cycles),the patients received a combination of progesterone vaginal sustained-release gel and dydrogesterone in group B(1293 cycles),the patients received a combination of progesterone injection and dydrogesterone in group C(887 cycles).Pregnancy outcomes and neonatal outcomes in group A,group B and group C were compared.Results The clinical pregnancy rate,the 12-week pregnancy rate and the live birth rate had no significant difference among the three groups(P>0.05).The rates of premature delivery and twin delivery[19.90%(78/392),30.61%(120/392)]in group C were higher than those in group B[13.61%(109/801),P=0.011;20.47%(164/801),P<0.001].The birth weight[(3178.60±635.38)g]in group B was significantly higher than that in group C[(3033.01±682.54)g,P<0.001].There was no significant difference in the incidence of birth defects among the three groups(P>0.05).Logistic regression analysis showed that three different luteal phase support regimens were not associated with 12-week pregnancy rate.Conclusion In HRT-FET cycle,progesterone soft capsule or progesterone vaginal sustained-release gel combined with dydrogesterone can achieve the same pregnancy outcome as progesterone injection combined with dydrogesterone,but a large-scale prospective study is needed.

关 键 词：黄体支持 冻融胚胎移植 激素替代周期 妊娠结局 

分 类 号：R714.8[医药卫生—妇产科学]